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Thursday 18 July 2019
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Practices need to implement a clinical safety team

Primary care providers need to invest in clinical safety teams, says Dr Ian Jackson
 
The clinical safety officer (CSO) role was originally developed following lessons learned during the national programme for IT.
 
The National Patient Safety Agency was commissioned to review the programme in 2004 – ultimately concluding that clinical safety was not being addressed in a proactive way.
 
Since its introduction, the CSO role has received mixed feedback from healthcare professionals. Initially there was very little interest, most likely due to the lack of understanding around new and emerging healthcare technologies.
 
The first set of guidelines were also cumbersome and difficult to follow. However, NHS Digital has since improved the guidance and encouraged the development of the role with a training and accreditation process.
 
Today, the position has become popular in secondary care; people clearly see the importance of IT saftey across the sector. Software developers have also become aware that they too have a duty of care, and many have introduced CSOs.
 
Within software development, the CSO role is to complete clinical safety analysis of any software being created to identify potential hazards for patients.
 
Each hazard is assessed against how likely it is to occur and the seriousness of the outcome for patients if it did.
 
With a few exceptions, the same recognition of the importance of the CSO role cannot be found in primary care, despite it being equally as essential in this sector.
 
As we move to implementing new systems, our focus is always on improving and futureproofing, so there is a vested interest in ensuring they integrate, allowing us to achieve interoperability across the NHS.
 
There is huge interest in the next generation of IT systems for primary care and a move to interoperability However, how many of these systems are being developed and implemented in accordance with the required clinical risk management procedures? 
 
For example, the move to teleconsultation and online patient symptom checkers are seemingly innocuous, but are practices completing safety assessments and ensuring that any potential patient risks are recognised and mitigated?
 
Bottom line, if we are implementing IT changes within the NHS that potentially has an effect on clinical work then clinical safety is important and the CSO role is necessary, not optional.
 
The structure in a primary care setting would need to be different, of course. We simply couldn’t have a trained CSO in every GP practice.
 
However, it could be something that is provided as part of a system. The primary care networks mentioned in the long-term plan, in which GP surgeries will work together, could prove to be the solution for the CSO role.
 
Also, nursing staff and various other medical professionals can now become CSOs. I can understand the reluctance for a small GP practices to even consider a role like this.
 
However, there really does need to be that someone who is responsible for the safe implementation of software, if the NHS is to truly embrace a digital culture. 
 
Dr Ian Jackson is medical director and clinical safety officer at Refero, a platform for collaboration across health and social care.